The Care Quality Commission
  • Hospice service

Barnsley Hospice

Overall: Outstanding read more about inspection ratings

104-106 Church Street, Barnsley, South Yorkshire, S75 2RL (01226) 244244

Provided and run by:
Barnsley Hospice Appeal

All Inspections

15 and 16 November 2022

During a routine inspection

We carried out a comprehensive inspection of this service as part of a follow up, as the service had previously been inspected in April and May 2021 and January 2022 and was rated inadequate.

At the last inspection we found significant safety concerns and we imposed urgent conditions using our section 31 powers on the service’s registration to drive improvement and ensure patients were safe. These conditions were specifically in relation to the clinical assessment review and risk identification of patients, admission assessment processes and COVID-19 management processes and policies. The application of conditions required the service to urgently complete a full review of all patient records to ensure appropriate documentation and risk management process were in place. We issue conditions where the care a service is responsible for, falls short of what is legally required, tell the service what was not right, and explain how long they have to comply with the regulations.

At this inspection we found the service had made significant improvements and had taken prompt action to comply with the regulations.

Our rating of this location improved. We rated it as outstanding because:

  • People are protected by a strong comprehensive safety system, and a focus on openness, transparency and learning when things go wrong. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. They followed national guidance to gain patients’ consent.
  • People were truly respected and valued as individuals and are empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
  • All staff were committed to continually learning and improving services.

However:

  • The service should consider auditing ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) forms.
  • The service did not provide leaflets in multiple languages.

11/01/2022

During a routine inspection

We carried out a comprehensive inspection of this service as part of a follow up, as the service had previously been inspected between 28 April 2021 and the 4th May 2021, rated inadequate and placed into special measures. Services placed in special measures are inspected again within six months.

At this inspection we found significant safety concerns and we imposed urgent conditions using our section 31 powers on the provider’s registration to drive improvement and ensure patients were safe. These conditions were specifically in relation to the clinical assessment review and risk identification of patients, admission assessment processes and COVID-19 management processes and policies. The application of conditions required the provider to urgently complete a full review of all patient records to ensure appropriate documentation and risk management process were in place. We issue conditions where the care a provider is responsible for, falls short of what is legally required, tell the provider what was not right, and explain how long they have to comply with the regulations.

We found the provider had made some improvements but there remained significant concerns and the provider remains in special measures. In addition, we told the provider that it must take prompt action to comply with the regulations.

Our rating of this location stayed the same. We rated it as inadequate because:

  • Staff did not have training in key skills and did not manage safety well. This is a re-occurring breach from the last inspection.
  • The service did not always control infection risk well. Staff assessed risks to patients but did not act on them. Staff did not always keep good care records. Records were not clear or complete. This is a re-occurring breach from the last inspection.
  • The service did not always manage safety incidents well and did not learn lessons from them. This is a re-occurring breach from the last inspection.
  • Managers did not monitor the effectiveness of the service well and did not make sure staff were competent for their roles by producing guidance and support through policy development.
  • The provider did not ensure staff understood their responsibilities when obtaining appropriate consent.
  • The service undertook limited planning to meet the needs of local people and did not take account of patients’ individual needs through personalised care planning.
  • Governance processes were not in always in place or embedded to ensure risk was identified and managed. The provider did not always collate performance data to ensure the quality of the service was measured and improved.

However:

  • The service had enough staff to keep patients safe and medicines were managed well. The provider had taken steps to improve medication reconciliation processes.
  • Patient feedback was generally positive.
  • Staff felt valued and praised the leadership of the service following the departure of several senior staff, this had improved from the last inspection.
  • Leaders of the service demonstrated a genuine willingness to learn and improve and build sustainable quality service for the future.

28 April 2021 29 April 2021 4 May 2021

During a routine inspection

We inspected this service in response to intelligence that indicated a potential risk that the quality of care was not up to standard. We found numerous significant issues of concern and have placed the service in special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Early in the inspection process, we issued three warning notices relating to the safe care and treatment of patients, the service’s capacity to safeguard patients from abuse and improper treatment, and the overall management of the service. We issue warning notices where the care a provider is responsible for falls short of what is legally required, tell the provider what was not right, and explain how long they have to comply with the regulations.

In addition, we issued the provider with 12 requirement notices and told the provider that it must take prompt action to comply with the regulations.

Our rating of this location went down. We rated it as inadequate because:

  • Staff did not have training in key skills, did not understand how to protect patients from abuse, and did not manage safety well.
  • The service did not always control infection risk well. Staff assessed risks to patients and acted on them but did not always keep good care records. They did not always manage medicines well. Records were not clear or complete.
  • The service did not manage safety incidents well and did not learn lessons from them. When things went wrong staff did not apologise or give patients honest information or suitable support.
  • Managers did not monitor the effectiveness of the service well and did not make sure staff were competent for their roles by providing support and development including making sure they understood their responsibilities under the Mental Capacity Act.
  • The service did not plan care to meet the needs of local people, did not take account of patients’ individual needs, and was not always inclusive. The service did not make it easy for people to give feedback.
  • People could not always access the service when they needed it and had to wait for treatment.
  • Leaders did not run services well using reliable information systems and did not support staff to develop their skills. Risks were not well managed, and performance was not measured effectively. Staff did not all feel respected, supported and valued. The service did not engage well with patients and the community to plan and manage services.

However:

  • The service had enough staff to care for patients and keep them safe.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff were focused on the needs of patients receiving care and were clear about their roles and accountabilities.

1 August 2016

During a routine inspection

Barnsley Hospice is an independent registered charity. It provides a 10 bedded in patient unit,day care and out patient services for people with a life-limiting illness. Referral to use the service is generally made by a doctor or specialist nurse. No direct charge is made to people using these services. Care is provided to people over 18 years of age who are resident in the borough of Barnsley.

Barnsley Hospice also offers treatment for patients suffering from cancer and non-cancer related oedema. The service is also available to those who have had cancer in the past. There are three Lymphoedema Practitioners who can see patients in their home, hospital or the clinic based at the hospice. (Lymphoedema is a chronic (long-term) condition that causes swelling in the body's tissues). Individual plans are created to include some of the following: skin care, exercise, massage and compression. The key element of this service is to enable patients to successfully manage Lymphoedema on a day-to-day basis.

Barnsley Hospice also provides a day service at The Limes support and therapy centre. The Limes is open Tuesday to Friday. The day service is designed to help patients adapt to the limitations caused by serious illness. Each patient is assessed individually and support is also available to their families and those close to them. The day service offers support and advice with symptom management and treatment. People benefit from socialising with people who are going through similar experiences. Refreshments and a meal are provided free of charge. Transport can be arranged if necessary. The care team providing support at the centre include registered nurses, an activity coordinator, doctors, complementary therapists and volunteers. If required there is access to a social worker, counselling service and spiritual support.

Barnsley Hospice has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Day-to-day operation of the hospice is delegated by the Board of Trustees to the Chief Executive Officer (CEO). The CEO discharges responsibilities through the Hospice Executive Team, comprising of the Patient Services Director, Consultant Clinical Lead , Support Services Director and Finance Director. The registered manager is also the CEO.

Hospice Practitioners provide medical cover together with four part time consultants in Palliative medicine.

24 hour cover by the medical team is provided. There is a system called ‘Pall Call’ in place at the hospice. ‘Pall Call’ is a specialist palliative care telephone advice line for health care professionals and is open 24 hours seven days a week. It is also available for patients and carers to call.

Our last inspection at Barnsley Hospice took place in November 2013. Barnsley Hospice was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 1 August 2016 and was unannounced. This meant staff at the hospice did not know we were coming. On the day of our inspection all 10 beds on the in-patient unit were occupied.

Staff were trained in how to protect people from the risk of abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs.

Robust and safe recruitment procedures were followed which meant suitable staff were employed to help keep people safe.

Systems were in place to maintain the safety of the hospice. The environment was well designed, welcoming, well maintained, clean and suited people’s needs.

People were supported to maintain a nutritious diet at the service and people told us about the high quality of the food. There was a choice of menu, drinks and snacks provided.

Staff told us they were supported through induction, regular on-going training, group supervision and appraisal. The registered manager said they had identified improvements in staff supervision were required and said they planned to increase the consistency and frequency of individual staff supervision within the next three months.

Staff worked within the principles of the Mental Capacity Act (MCA) where appropriate. People had choices about their care and their consent was sought by staff. They told us they were involved in all decisions about their care.

People, who used the service, and their families, told us that they were treated with kindness and respect.

People were encouraged to be involved in making choices regarding their care and treatment.

People’s care plans we looked at reflected people’s needs and gave information about their treatment regimes.

There was a complaint’s process in place. We found the service had a robust process in place to enable them to respond to people and/or their representative’s concerns, investigate them and take action to address their concerns.

We received very positive comments regarding the overall management of Barnsley Hospice from staff, other care professionals, relatives and people who used the service.

Quality assurance and clinical governance systems were in place and were used to improve the service.

4 November 2013

During a routine inspection

During the inspection we were able to observe people's experiences in the hospice. We found that care and support was offered appropriately to people. We saw staff treated people with dignity and respect.

We talked with five patients and four relatives during our inspection. Patients told us they were happy with care at the hospice, liked all the staff who looked after them, thought the hospice was kept clean and they enjoyed their food. Some comments captured included, 'my whole experience here has been brilliant', 'the staff are remarkable, they not only offer fantastic support to patients but to our family as well', 'the staff are brilliant, the care they provide is superb', 'nothing is too much trouble, staff go the extra mile to provide excellent care', 'the staff here are wonderful we see them as our extended family' and 'this is a wonderful, special place.'

We found that people's needs were identified in care plans. Records showed that people had been involved in the care planning process.

Patients were supported to have adequate nutrition and hydration.

The environment was clean and patients had access to surroundings that were conducive in supporting their health and welfare.

We found there were processes in place to ensure the safety, availability and suitability of equipment.

We found there were effective recruitment and retention processes in place.

14 January 2013

During a routine inspection

We spoke with three patients and four visiting relatives. They all spoke very positively about their experiences at Barnsley Hospice. They told us they were 'extremely' happy with care at the hospice, liked all the staff who looked after them, thought the service was kept clean and enjoyed their food. Some comments captured included, 'a special place with special staff', 'brilliant staff I can't fault any of them',' all the staff here are wonderful, from the moment you walk through the door ,you know how special it is here' and 'this is not an unhappy place, I have never met such wonderful staff.'

We found a clean warm service with a relaxed and friendly atmosphere. The staff team, including volunteers, showed a real desire to provide a high level of care and service to patients and relatives who were staying or visiting the hospice.

We found that patient's needs were identified in care plans. Patients and their relatives had been involved in the care planning process.

Medication records checked were up to date and regular audits of medication systems were undertaken.

We found that there were sufficient numbers of staff provided to meet patient's needs.

We found that a complaints policy and procedure was in place. Patients had been provided with information on how to make a complaint. All of the patients and their relatives spoken with said they had no complaints or concerns about the hospice.

9 November 2011

During a routine inspection

We did not look at the Day Care Services during our visit, but spent our time in the In-Patient Unit. We spoke with two people staying there. We were unable to speak with more people because of other people's particular care needs on the day we visited.

Those individuals that we spoke with however told us they were very satisfied with the care and support provided. Their comments include 'I get brilliant care'. And 'I wanted to come back here. They looked after me so well last time'. They commented positively about the care staff who supported them, saying 'They're all angels.' And 'The nurses come quickly if I ring my bell. They're all wonderful.' They told us they felt 'safe and secure' there, and trusted the staff with whom they came into contact.

People commented positively about the food served there and the cleanliness of the environment. No-one we spoke with at the hospice made any negative comments about the service and how it was being run.